The Lure of Foreign Lands: Is the peripatetic lifestyle calling you?

So the time has come for you to move on. But where? The hospital down the street, the hospital in the next city, or something farther afield? Consider working abroad, but remember it's not for everyone. So as the excitement of a foreign adventure brews and your feet start getting itchy, consider a few things:

Before You Decide to Apply

Do you really want to work abroad? Or is it just a part of a fantasy lifestyle you've created for yourself: The Adventures of Me, Jet-setting Healthcare Professional! Working abroad is not the same as being on a permanent vacation.

How long do you want to work abroad? Locums (short-term contracts) for most healthcare professionals are rare items, though these can sometimes be found for doctors. Generally contracts are for one or more years. If you want something very short, maybe you should look into options for volunteer medical missions (see Want to Volunteer?).

What language(s) do you speak? An English-speaking healthcare professional cannot reasonably expect to show up at a hospital in downtown Country X, where all the staff and patients speak Xish, and get a job. But language is not always a barrier in foreign-speaking lands. For example, countries like Saudi Arabia, Qatar, and the United Arab Emirates have been employing Western (and other) healthcare staff for decades, so the working language at the major hospitals is English, and they have translators available when working with patients who do not speak English.

Are you free to take off or do you have a family to think about? If you have a family, there are numerous issues to consider:

• Are you expecting to bring them? Not every contract permits this. Particularly regarding positions in the Middle East, "single status" contracts (that do not allow a spouse and/or children) are most common for non-MDs. And even if your family can go, is it the best thing for them now?

• If you have and can bring school-aged children, are there schools available in your language, in the location? And if yes, is tuition paid by your employer? If not, can you afford the tuition? If there are no schools, can you afford to (or do you want to) send your children to boarding school?

• If you have and can bring your spouse/children, but their expenses are not covered by your employer, can you afford airfare for them all to/from Country X?

• What about healthcare insurance? Does your employer provide this for you? Is it covered for your family members? If not, can you obtain and afford healthcare insurance for them?

• If you were considering leaving a spouse and/or children behind, is this really in their best interests – and yours? Having worked in international recruitment, I know this can go both ways: sometimes it works, but sometimes a person misses her/his spouse/children too much, are pressured by family members/significant others to return, the children begin to have "issues" which the babysitting family members can't handle, or …

• Does your spouse want/need to work? If so, can s/he find work, whether due to visa restrictions or their particular career – for example, there would not be huge demand for marine biologists in land-locked Luxembourg.

• A related issue is the presence of a significant other to whom you are not married. Check with individual countries: in some, you cannot "import" someone to whom you are not married. And if your significant other can come with you, the same issue applies as with a spouse – does the person want/need to work? If so, can s/he find work?

• Do you have elderly or ill parents or relatives who you may have to return home to care for, thus resulting in you breaking a contract?

Are you interested in working abroad only for money? Working abroad is not necessarily a financial bonanza. For healthcare professionals from the US and Canada, salaries are usually less than or similar to what they make at home (and keep in mind other potential expenses like those mentioned above regarding children). And a caveat: beware of companies claiming that you can make enormous sums of money – one of the recent claims is that you can earn more than US$100,000 for a few months work in Iraq or Kuwait – if the claim sounds too good to be true, it probably is.

Nonetheless, remember that even if the salary is not a windfall, there can be other positive financial considerations. Some countries, like Saudi Arabia, Qatar, and the United Arab Emirates, do not have tax, and if you qualify for non-resident tax status in your own country (Americans, see the Internal Revenue Service; Canadians, see Canada Customs and Revenue Agency and our article Expatriate Tax Status for Canadians) your foreign income will also be tax-free at home. In other countries, you will have to pay tax on earnings and purchases. Working in the UK is popular, but the cost of living in some areas, like London, is astronomical. Along with salary, consider the tax rate and cost of living in the location.

Is your license transferable to the foreign country, or would you have to write their local licensure exam. If you would have to write the exam, do you want to?

How is your health? Whether you have acute or chronic concerns, you may want to stay close to your own healthcare providers. And some countries may not grant you a work visa if you have health problems.

Similarly, age can be an issue for some countries, in that permissible ages for employment visas may be capped, both regarding youngest permissible and oldest permissible. And if you wanted to travel on the popular "working holiday" visa in countries like the UK, beware: You're over the hill at age 30. Having dual citizenship (e.g. US or Canada and a country of the European Union) makes working abroad easier.

And as we asked in our article, Want to Volunteer?: are you high maintenance? Face it. Some of us are. Can you handle the differences that you will experience professionally and personally, such as not having everything up to your familiar hospital standards; not having all of your favorite modern conveniences; not having access to your favorite TV program; and/or not having your favorite junk food?

When Abroad

So you are abroad – what should you do? Aside from general moving issues (see I Never Knew I Knew So Many People) and what to pack, remember:

• Be aware of culture shock. Even if you go to another Western nation, it can be strange not to hear your own accent, not to be able to buy your favorite candy, or not to be able to watch your favorite soap opera.

• Deal with culture shock: associate with positive people; explore your new environment and all it has to offer; remember that you don't have to like everything about the new place; if you do find something you don't like, try to do constructive things to improve your situation, and look on things with humor rather than scorn; if you don't speak the language, learn it – not necessarily fluently, but enough to find out where the toilet is and where the best bargains might be found; remind yourself that adapting takes time; keep active; take time to relax; keep in contact with home; build contacts within your own ethnic community in the new country and celebrate holidays from home like, Thanksgiving or, for Americans, July 4th and, for Canadians, July 1st.

• A bit more on the above: keep in contact with friends and family at home. They can not only help you with any paperwork you may have to deal with from home, but keeping ties will help your transition home be easier – you want to minimize reverse culture shock, after all!

• In the new country, register with your country's embassy or consulate.

• Make sure you complete any required CE credits to keep your license – and make sure you keep your license active.

Onto New Adventures

Plan ahead for when it's time to go home or move on. Unless you want time off, investigate options and apply for positions while you are still overseas. And unless you're planning a permanent retirement when you get home, don't forget to obtain copies of references from your positions overseas.

In Summary

As you consider whether you truly want to work abroad, remember the words of G.K. Chesterton: "An adventure is only an inconvenience rightly considered. An inconvenience is only an adventure wrongly considered."

Where to Look for Healthcare Jobs Overseas

Government:

• Americans: US Department of State

• Canadians: Public Service Commission of Canada

Agencies: While most agencies do not charge applicants a fee, some do. And, unfortunately, while charging is not standard, it also does not provide quick, easy proof that an agency is shady. For example, the well-known International Schools Services, which hires teachers and administrators for International Schools overseas (who may be educating your children), charges a US$150 Application/File Establishment Fee.

MedHunters: Currently MedHunters has opportunities in:

• Bermuda

• The Cayman Islands

• The Marshall Islands

• Saudi Arabia

• The United Arab Emirates

• Qatar

• Australia

• New Zealand

• The United Kingdom

Locations available change, so check MedHunters regularly for jobs in other international locations.